Equipment Financing Application

Equipment Financing Application
New ApplicationAdditional AccountAdditional LocationOwnership Change
Business Information
Business Legal Name*
Legal Name as it appears on tax return
DBA
Shown on Cardholders Statement
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Business Phone Number*

Area CodePhone Number
Fax Number

Area CodePhone Number
E-mail*

Confirmation Email
Website Address*
Company Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Sole ProprietorshipPartnershipCorporationOther
State of Legal Formation*
Business and Credit Info
0-1 Years1-2 Years3-4 Years5 years +
Country of Primary Business Operations*
Gross Monthly Volume*
(Round to the nearest whole dollar)
Goods or Services Provided*
Owner(s) Name*

PrefixFirst NameMiddle NameLast Name
Ownership Percentage?*
Owners Birth Date*

MonthDayYear
Owners Birth Date
Additional Owner(s) Name

PrefixFirst NameMiddle NameLast Name
Additional Owners Percentage?
Additional Owners Birth Date

YearMonthDay
Date
Government Issued ID#*
State Issued*
Expiration Date*

MonthDayYear
Date
Citizenship Country*
Social Security Number*
Owners Residence Address*

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone*

Area CodePhone Number
Accounts Payable Fax

Area CodePhone Number
Owners E-mail*

Confirmation Email
Company to Bill Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Federal Tax ID Number*
*If your Tax Identification Number or legal Tax Filling Name does not match IRS records, a monthly TIN MISMATCH fee of $7.95 will be assessed
Bank Name*
Bank Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Bank Phone Number*

Area CodePhone Number
Business References
Business Bank Name*
Business Bank Account Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Fax Number

Area CodePhone Number
Type of Account
Reference 2: Company Name
Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number 2

Area CodePhone Number
Fax Number 2

Area CodePhone Number
Type of Account 2
The Merchant and Owner(s)/Officer(s) identified above (individually, an “Applicant”) each represents, acknowledges and agrees that (1) all information and documents provided to GoKapital, Inc. (“Company”) including all information provided or included are true, accurate and complete, (2) Applicant will immediately notify Company of any change in such information or financial condition, (3) Applicant authorizes Company to disclose all information and documents that Company may obtain including credit reports to other persons or entities (collectively, “Assignees”) that may be involved with or acquire commercial loans or purchases of future receivables including Merchant Cash Advance transactions, including without limitation the application therefore (collectively, “Transactions”) and each assignee is authorized to use such information and documents and share such information and documents with other Assignees, in connection with potential Transactions, (4) Each Assignee will rely upon the accuracy and completeness of such information and documents (5) Company, Assignees, and each of their representatives, successors, assigns and designees (collectively, “Recipients”) are authorized to request and receive any investigative reports, credit reports, statements from creditors or financial institutions, verification of information, or any other information that a recipient deems necessary, (6) Applicant waives and releases any claims against Recipients and any information providers arising from any act or omission relating to the requesting, receiving or release of information, and (7) Each Owner/Officer represents that he or she is authorized to sign this form on behalf of Merchant.
Enter the word as it's shown*
DocuSign*
Voided Check*

Browse Files
Account where the settlement funds should be deposited Cancelof
EIN Document*

Browse Files
SS-4 Documentation Cancelof
Articles of Incorporation*

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Articles of Incorporation Cancelof
Owners Drivers License*

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State Issued Drivers License of Owner Cancelof
Last 3 Months Bank Statements*

Browse Files
(If new account, then 3 months of recent owner personal bank statements) Cancelof
Should be Empty:

Equipment Financing Application

Business Information

Business and Credit Info

Business References